Location: La Jolla, San Diego
This position is eligible to participate in the Director Incentive Plan.
As Director, Provider Network Management, you will be responsible for creating and maintaining a comprehensive contracted provider network to serve Scripps Health Plan members.
What will you do? - Oversee the credentialing, provider database, contracting, and provider relations teams.
- Lead provider relations functions, including training, problem-solving, and provider satisfaction initiatives for all medical groups, IPAs, institutional providers, and ancillary providers.
- Be responsible for Customer Service related to both member and provider inquiries.
- Maintain provider directories for all contracted IPAs and medical groups.
- Support Scripps' integrated delivery system. Scripps Health Plan operates as both an MSO and a KK-licensed plan for large commercial groups.
- Manage relationships related to Scripps Health Plan's plan-to-plan risk arrangements with major HMO plans.
Serve in a role that blends financial analysis, contract negotiations, operational efficiency, and system-wide impact, working extensively with Scripps Health Plan Services, stakeholders across the organization, and external providers and vendors.
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Qualifications Required Education/Experience/Specialized Skills: - At least seven years combined experience in management of provider relations and contracting at the plan, medical group /IPA level of which four years must be in a leadership capacity.
Preferred Education/Experience/Specialized Skills/Certification: - Masters degree in healthcare administration or similar
- Epic Tapestry experience
- Negotiation skills, creating policies and procedures and leading multiple teams.
